The spectrum of systemic treatments has been widely enlarged since the advent of biologics. Patient-perceived treatment benefit is undoubtedly a major aim of psoriatic treatment. To clarify the degree of patient-perceived satisfaction with recently available treatments including biologics, we utilized a questionnaire survey of patients suffering from psoriasis as well as their physicians. Degree of perceived satisfaction with treatment was found to differ by severity and areas of the lesions, treatment methods, and Dermatology Life Quality Index (DLQI) scores. In addition, a gap of 27.8% in comprehensive satisfaction with treatment was detected between physicians and patients. Perceived satisfaction with treatment was further examined according to DLQI score, demonstrating a reduction in perceived satisfaction with increasing DLQI score. These results suggested that minimizing the physician-patient gap in perceived satisfaction with treatment will require maximizing patient perceived satisfaction, underscoring the need for a treatment strategy to attain a DLQI of 0 or 1. Since biologics exert strong therapeutic effects clearly distinct from those achieved with preexisting treatments, biologics are considered effective therapeutic tools to enhance patient-perceived satisfaction and to improve patientsʼimpaired QoL.
We have summarized the clinical data from 29 patients with cutaneous angiosarcoma (Scalp 23, Chest 3, lower abdomen 1, lower extremity 2) treated in Kyoto University during the past 23 years. The average age at the first visit to our hospital was 69.48 (50–88) years, and the gender ratio was 16 male; 13 female. The number of patients with angiosarcoma has recently been increased in our facility. The goal of the therapy is “to perform complete tumor resection or to control tumors at local sites”, because the most common cause of death has been distant metastases mainly in the lung. No curable therapy is currently available although many kinds of combined therapy with surgery, radiation and chemotherapy have been employed at various site. In our facility, we have performed surgery, radiation therapy and IL-2 local injection as local treatments, and chemotherapy and IL-2 drip infusion as systemic therapies; our therapeutic strategy has changed during these 23 years. Of the attempted treatments, combined surgery and chemotherapy with taxane appears to be one hopeful treatment that is effective in reducing tumor volume.
Examining 71 patients who were receiving chemotherapy for various malignancies from January 27 to October 31, 2011, we found that 30 of 71 patients (42%) had red lunulae on their finger nails. Univariate analyses revealed a statistically significant relationship between red lunulae and molecular targeted therapies, especially with EGFR inhibitors, and with adverse cutaneous effects such as folliculitis and paronychia. Although the exact mechanism of red lunular development is unknown, we suspect that an altered keratinization caused by these medications could make the transitional zone of the lunula less opaque and make the underlying vessels more visible, appearing as a red lunula.
A 55-year-old woman first noticed a subcutaneous nodule with a diameter of 1 cm on the right sole of her foot a year earlier. It became hard and painful after massage. Ultrasonography revealed a low echoic mass with posterior echo enhancement that changed into a somewhat higher echoic mass with little posterior echo enhancement after massage. Histological examination revealed an intravascular papillary endothelial hyperplasia. Such a change in ultrasonography findings before and after massage has not been previously reported.